Provider Demographics
NPI:1548835903
Name:RHULE, LATANDRA L (NP-C)
Entity type:Individual
Prefix:
First Name:LATANDRA
Middle Name:L
Last Name:RHULE
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 INTEGRA VILLAGE TRL APT 156
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-9312
Mailing Address - Country:US
Mailing Address - Phone:334-701-0377
Mailing Address - Fax:
Practice Address - Street 1:120 INTEGRA VILLAGE TRL APT 156
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-9312
Practice Address - Country:US
Practice Address - Phone:334-701-0377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-26
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11013286363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily